血管ベーチェットが疑われた高齢発症の腹部大動脈瘤の1例

A Case of Abdominal Aortic Aneurysm Suspected to Arise from Vascular Behçet's Disease

　血管ベーチェットが疑われた腹部大動脈瘤の1例を経験した．症例は68歳，男性．37歳時に副睾丸炎の既往がある．発熱，体重減少，関節痛があり，口腔潰瘍，右上腹部拍動性腫瘤の精査目的で入院となった．入院時，白血球増加，CRP上昇，血沈の亢進を認め，抗核抗体陽性，HLA typingではB51が検出された．腹部CT上，大動脈壁の肥厚および石灰化を伴う嚢状大動脈瘤を認めた．腹部大動脈造影では上腸間膜動脈下部の嚢状大動脈瘤を認めた．経過が急速であり，血管ベーチェットの大動脈瘤と考え，人工血管置換術を施行した．周囲への癒着，浸潤は認めず，病理組織では炎症細胞の浸潤と中膜弾性線維の破壊を認めた．高齢発症であるが，臨床経過，検査所見，組織所見より血管ベーチェットによる腹部大動脈瘤が考えられた．血管ベーチェットの動脈瘤は予後不良であることから，同疾患が疑われた場合，外科手術も念頭においた早期診断，治療が重要と考えられた．

We encountered a patient with abdominal aortic aneu-rysm suggesting vascular Behçet's disease. A case of a 68-year-old male who had a past history of epididymitis at the age of 37 years. Fever, weight loss and arthralgia developed, and the patient was hospitalized for detailed examination of oral ulcer and a pulsating phyma in the right upper abdomen. On admission, leukocytosis, the increased C reactive protein (CRP) level and enhanced erythocyte sedimentation rate were noted. The patient was positive for antinuclear antibody. Human leukocyte antigen (HLA) typing detected B51. Abdominal comput-ed tomography (CT) revealed a saccular aortic aneur-ysm with aortic wall thickening and calcification. Radio-graphy of the abdominal aorta revealed a saccular aortic aneurysm below the superior mesenteric artery. The course was rapid, and under a diagnosis of aortic aneurysm caused by vasculer Behçet's disease, artificial blood vessel replacement was performed. Adhesion and infiltration to the periphery were not observed. His-topathology revealed infiltration of inflammatory cells and destruction of medial elastic fibers. Despite onset at an advanced age, the clinical course findings on exami-nation and histological findings suggested abdominal aortic aneurysm caused by vasculer Behçet's disease. Aneurysms caused by vasculer Behçet's disease have a poor prognosis. Therefore, early diagnosis and treat-ment including such surgery as indicated should be performed when this disease is suspected.